Although the assessment of right ventricular (RV) function is important in the clinical management of children with congenital heart disease, available imaging techniques have been limited because of the complex geometry of the right ventricle. A new Doppler index combining systolic and diastolic time intervals (the Tei index) has been reported to be useful for the assessment of global RV function in adults. However, normal values in children, age-related changes, and the clinical utility of the Tei index with regard to congenital heart disease have not been demonstrated. The purpose of this study was to prospectively assess RV function in children with normal heart and congenital heart disease using the Tei index. The subjects included 150 healthy children and 43 patients with congenital heart disease (35 patients with atrial septal defects and 8 patients who had had a Senning operation). The index was defined as the sum of isovolumetric contraction time and isovolumetric relaxation time divided by ejection time and was measured from conventional RV outflow and inflow Doppler velocity profiles. The Tei index was not affected by age in healthy children (0.24 +/- 0.04). There was a significant difference in index rating between patients who had had a Senning operation (0.58 +/- 0.09) and healthy children (p < 0.01), but there was no significant difference between children with atrial septal defect (0.25 +/- 0.13) and healthy children. The Tei index is a feasible approach to use when assessing global RV function in children with congenital heart disease.

1. Using isolated pulmonary resistance vessels from mature fetal lamb and chronically instrumented lambs (8-17 days old), we have examined whether hypoxic pulmonary vasoconstriction is sustained by activation of a constrictor mechanism or suppression of a dilator mechanism. 2. Hypoxia contracted both arteries and veins in vitro, and the contraction was greater with the former. After removing the endothelium, arteries responded faster to hypoxia, but the magnitude of the response remained unchanged. 3. Hypoxic arteries, unlike normally oxygenated arteries, did not contract with either indomethacin (2-8 uM) or NT-nitro-L-arginine methyl ester (L-NAME, 100 UM). The same vessels relaxed with sodium nitroprusside (SNP, 0.001-10 /1M) but not with bradykinin (0-1-100 nM).4. Endothelin-1 (ET-1, 0-01-10 nM) contracted isolated arteries and veins under normoxic and hypoxic conditions. In both vessels, the contraction was fast in onset and subsidence, and was inhibited by the ETA receptor antagonist BQ123 (1 /SM). The ET-1 precursor, big ET-1 (100 nM), also contracted arteries and veins, but compared with ET-1 its action was slower in development. Big ET-1 contraction, unlike ET-1 contraction, was curtailed by the inhibitor of the ET-1 -converting enzyme, phosphoramidon (50 ,UM). 5. ET-1 (01-10 nM) had no effect on isolated arteries precontracted with a thromboxane A2 (TXA2) analogue (ONO-11113) and treated with BQ123 (10 ,UM). Under the same conditions, ET-1 relaxed the veins. Accordingly, in the absence of BQ123 treatment, the selective ETB receptor agonist IRL-1620 (0-1-100 nM) relaxed the contracted veins but not the arteries.6. BQ123 (10/M) inhibited the constriction of isolated arteries and veins to hypoxia.Likewise, in the conscious lamb a bolus of BQ123 (0 4 mg kg-', injected into the pulmonary artery) curtailed the rise in pulmonary vascular resistance (Rpa) brought about by alveolar hypoxia without changing significantly systemic vascular resistance (Ra0). Under normoxia, Rpa was insignificantly affected by BQ123.7. The results indicate that pulmonary resistance arteries are more susceptible to hypoxia than the veins, and that hypoxic vasoconstriction does not require an intact endothelium to occur. Hypoxic tone is ascribed primarily to intramural generation of ET-1, while removal of the tonic action of a relaxant may only have an accessory role in the response.It is well known that the pulmonary vasculature constricts optimal matching of blood flow to alveolar hypoxia when ambient oxygen tension falls below the normal range (Fishman, 1990). In its extreme manifestation, hypoxic (reviewed by Fishman, 1990). This response is evident in vasoconstriction may lead to pulmonary hypertension

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We report a neonate with aneurysmal dilatation of the vein of Galen diagnosed prenatally by color Doppler sonography and MRI at 37 weeks' gestation. The child was treated by transarterial embolization of micro-coils 2 and 8 days after birth. The aneurysmal dilatation of the vein of Galen markedly decreased after embolization and the patient is developing normally at 2 years 5 months of age. Prenatal diagnosis and early intervention by transarterial embolization produced in a good outcome in this patient.

Neurology and general medicine: the neurological aspects of medical disorders. New York Churchill Livingstone, 1989431-447. 4. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988;8(suppl 7): 1-96. 5. Newman LC, Lipton RB, Solomon S. The hypnic headache syndrome. In: Rose FC, ed. New advances in headache research. London: SmithGordon and Company LM., 1991:31-34. 6. Goadsby PJ, Lipton RB. A review of paroxysmal hemicranias, SUNCT syndrome and other short-lasting headaches with autonomic feature, including new cases [review article]. Brain 1977;120:192-209. 7. Newman LC, Lipton RB, Solomon S. The hypnic headache syndrome: a benign headache disorder of the elderly. Neurology 1990;401904-1905. 8. Mosek A, Dodick DW. The hypnic headache syndrome: the Mayo Clinic Experience.The biological basis of handedness remains to be determined in humans. Hepper et a1.l supported the genetic explanation of handedness by demonstrating a preference for thumb sucking before birth. However, Dryden2 rejected this hypothesis and proposed that handedness was related to neuromuscular development secondary to the oxygen level in the blood.We have now confirmed the independence of handedness and the asymmetric position of the viscera in humans. We assessed the relationship between the physical laterality of the internal organs and handedness in 16 healthy Japanese subjects with situs inversus universalis. We studied eight males and eight females (age range, 7 to 91 years; mean, 35 years). All subjects had dextrocardia without congenital heart disease.Subjects were not mentally retarded and they had no psyehiatric disorders, autoimmune disease, or the asplenic syndrome. One subject was blind, which excluded the determination of eyedness in this individual. Subjects were assigned to the right-handed group if they wrote, drew, and threw a ball with the right hand. Right-eyed meant the subject used the right eye when looking through a camera or telescope. Right-footed was defined as use of the right foot when kicking a ball. The subjects with left handedness, and those with mixed handedness, footedness, and eyedness were assigned to the "nonright" group. Statistical analysis was performed using the chi-squared test.About 90% of the population is right handed.3 We found that 15 of the 16 subjects (94%) with situs inversus universalis were right Table Behavioral preferences in subjects with situs inversus universalis Handedness Footedness Eyedness* (n = 16) (n = 16) (n = 15) ~~ Right 15 (93.8%) 15 (93.8%) 11 (73.3%) Nonright 1(6.3%) 1(6.3%) 4 (26.7%) Z t 3.5 3.5 1.8 Probability 0.0005 0.0005 0.0707 * Excluded one individual who was blind.t Right-handed bias.handed (table), consistent with the incidence of right handedness in normal people. In addition, 15 of the 16 subjects (94%) were right footed, again consistent with the incidence observed in normal people.' These data excluded a significant relationship betw...